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British Medical Bulletin Advance Access published online on November 26, 2008
British Medical Bulletin, doi:10.1093/bmb/ldn043
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© The Author 2008. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

A ‘pain-free’ death

Fiona Hicks* and Elizabeth Rees

Department of Palliative Care, Leeds Teaching Hospitals Trust, UK

* Correspondence to: Dr F. Hicks, Palliative Care Team, First Floor, Robert Ogden Centre, St James' University Hospital, Leeds LS9 7TF, UK. E-mail: fiona.hicks{at}leedsth.nhs.uk

Background: The time around a patient's death is often filled with sadness, but good medical and nursing care can provide comfort to patients and their carers at this critical time. For many, a ‘pain-free’ death is a priority although there are other aspects to providing good care at the end of life. Honest, open discussion with patients and carers about their wishes is an essential prerequisite to individualized care.

Sources of data: Relevant literature was reviewed with regards to policy, education and delivery of end of life care.

Areas of agreement: Pain management must be tailored to the individual with due regard to the route of analgesic administration in those unable to swallow, and consideration to the other circumstances surrounding a person's care. All staff caring for dying patients should address pain as a priority in managing end of life care, to promote the best possible death for patients and prevent undue distress for carers and staff.

Areas of controversy: This review has approached patient care at the end of life within current UK legislation, outlining what can be done to promote a ‘pain-free’ death. Debate continues about the role of euthanasia within end of life care and the use of analgesics and sedatives in pain management in terminal care.

Growing points: There is a range of tools available to help staff to care for dying patients, such as the Liverpool Care Pathway (LCP) for the Dying. It is most effective when introduced as part of a wider system of staff education in relation to terminal care.

Areas timely for developing research: Research into care of the dying will continue to be challenging. Priorities include; whether the use of tools such as the LCP improve the care patients receive, and the development of routine outcome measures including validated reports from patients and proxies.

Keywords: pain • terminal care • end of life care • review

Accepted for publication November 4, 2008.


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